MEDICARE: OAKCLIFF DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1972213544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKCLIFF DENTAL PLLC

Provider Business Mailing Address
First Line	:	2425 S COCKRELL HILL RD STE A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-8134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 S COCKRELL HILL RD STE A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-8134
Country	:	US
Telephone Number	:	972-285-2600
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	IHNBAE CHO
Credential	:
Telephone Number	:	520-906-5765

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/22/2022

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